KIDCARE MEMBER HANDBOOK

Transcription

1 KIDCARE MEMBER HANDBOOK KC 3793 (N-3-02)

2 THIS HANDBOOK IS ONLY FOR CHILDREN AND PREGNANT WOMEN. IF YOU ARE AN ADULT AND NOT PREGNANT, YOU SHOULD CALL YOUR ILLINOIS DEPARTMENT OF HUMAN SERVICES (DHS) LOCAL OFFICE ABOUT MEDICAL COVERAGE, REPORTING CHANGES AND ANY QUESTIONS THAT YOU HAVE. LEARN THE NUMBER OF YOUR DHS LOCAL OFFICE.

3 THIS KIDCARE MEMBER HANDBOOK IS FOR YOU! MAKE THE MOST OF KIDCARE AND USE YOUR HANDBOOK! It contains valuable information about KidCare health benefits and services for children age 18 or younger and for pregnant women. The Handbook talks about the KidCare Plans gives tips on keeping healthy lists helpful ideas for pregnant women has guidelines for using KidCare benefits and getting additional service includes steps to getting health care tells how to take care of problems The Handbook has many special features starting on page 76: a personal KidCare information sheet charts for keeping track of shots (vaccinations) and checkups definitions of words you need to know important phone numbers and websites information on interpreters, KidCare numbers and the KidCare website Please take time to look at the KidCare Member Handbook. Be sure you know how KidCare can help to keep you and your children healthy! Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ) 1

4 Your Guide To The KidCare Handbook Part 1. Welcome To KidCare (pp. 3-4) What Is KidCare? Health Care Through KidCare Part 2. KidCare Health Plans (pp. 5-34) KidCare Assist KidCare Moms & Babies KidCare Share KidCare Premium KidCare Rebate Medical Bills Before You Applied For KidCare Renewal Part 5. Using Your KidCare Benefits (pp ) Finding A Personal Doctor Specialists Immediate Care Or Urgent Care Emergency Care Family Planning Transportation To Medical Care Mental Health And Substance Abuse Part 6. Other Services/Benefits (pp ) Family Case Management WIC Child Support Part 3. KidCare Health Services (pp ) KidCare Advantage Personal Doctor Preventive Health Care Medical Services Checkup Visits Children And Their Shots Dental Services Vision (Eye) Services How To Get Help You Need Children With Special Health Care Needs Part 4. KidCare For Pregnant (pp ) Women Health Care Right Away Prenatal Care Your Baby Part 7. How To Get Medical Care (p.59) Part 8. Taking Care Of Problems (pp ) Complaints Appeals & Fair Hearings Grievances Civil Rights Fraud And Abuse Part 9. Special Features (pp ) Personal Information Sheet Children And Their Shots Chart To Keep Track Of Checkups Words You Need To Know Important Phone Numbers And Websites Information On Interpreters, KidCare Numbers And KidCare Website Notes 2 Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: )

5 KIDCARE - KEEPING YOUR KIDS HEALTHY PART 1. WELCOME TO KIDCARE What Is KidCare? KidCare is a health insurance program. KidCare helps pay for health care for children 18 or younger and pregnant women who live in Illinois. KidCare may pay a rebate to families who already have health insurance for their children. (Rebate: families receive money to help pay health insurance premiums for their children.) KidCare is a program of the Illinois Department of Public Aid (DPA). Health Care Through KidCare: Many doctors and other health care providers accept KidCare insurance. With KidCare, you decide where to go to get health care. Remember to be sure the doctors and other health care providers accept KidCare. Tell them I have KidCare insurance. Do you take KidCare? If your children see a doctor or health care provider that does not accept KidCare, you have to pay the bill. If you need help finding a doctor or health care provider, call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ). Monday-Friday 8:00 a.m. - 6:00 p.m. If you are in a managed care plan (Americaid, Harmony Health Plan, Humana Health Plan, United Health Care of Illinois, Family Health Network), call the managed care plan for help in getting a doctor or health care provider from its list. See page 59 for more on a managed care plan. Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ) 3

6 KIDCARE - KEEPING YOUR KIDS HEALTHY KidCare Plans: There are five KidCare Plans KidCare Assist KidCare Moms & Babies KidCare Share KidCare Premium KidCare Rebate A person can only be enrolled in one plan at a time. Each plan has its own rules. Read the rules for your plan on the following pages. 4 Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: )

7 KIDCARE ASSIST KIDCARE - KEEPING YOUR KIDS HEALTHY PART 2. KIDCARE HEALTH PLANS KidCare Assist an adult Health Care For Children 18 Or Younger If you are an adult, you should call your local office about medical coverage, reporting changes and any questions that you have. Benefits: KidCare Assist pays for covered medical services. See Part 3 and Part 5 to learn how to get health care for your children. Contact Office: Call your Department of Human Services (DHS) Local Office if you have questions about KidCare Assist. If you don t know the number, call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ). I.D. Cards: You get a new MediPlan Card every month. Keep the MediPlan Card. You must show it to doctors or health care providers when your children get health care. Do not give the MediPlan Card to anyone. The MediPlan Card is printed on white paper. The front of the card lists a case I.D. number and dates the MediPlan Card covers. The back of the card gives the names and birth dates of all family members who get KidCare. An individual I.D. number is listed next to the name of each person. This number is used by doctors and health care providers to bill KidCare. Report any errors that you notice on the card to your DHS Local Office. See sample MediPlan Card on next page. If you lose your MediPlan Card or you do not get one at the beginning of the month, call your DHS Local Office. Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ) 5

8 KIDCARE - KEEPING YOUR KIDS HEALTHY KIDCARE ASSIST Front of KidCare Assist MediPlan Card: State of Illinois - Department of Public Aid MediPlan Case ID Number Eligibility Period Doe, Jane R Through CASELOAD Z99 X IMAGINARY, JANE DOE 45 ANYPLACE ROAD YOUR TOWN, IL DPA 469KC (R-1-90) IL Note: The seal of the State of Illinois appears in blue ink in the spot marked with a large X in a circle. Back of KidCare Assist MediPlan Card: Eligibility Period Through Case ID Number IMAGINARY, JANE DOE 45 ANYPLACE ROAD YOUR TOWN, IL ONLY THE FOLLOWING PERSONS ARE ELIGIBLE: IMOGENE IMAGINARY ID#: DOB: 05/06/90 MEDICAID FANTASY IMAGINARY ID#: DOB: 06/03/95 MEDICAID TPL: A001 ****************************************************************************** TOTAL NUMBER OF COVERED PERSONS: Please see front of card for important information- x 6 Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: )

9 KIDCARE ASSIST KIDCARE - KEEPING YOUR KIDS HEALTHY Length Of Coverage: KidCare Assist may continue up to one year at a time. Your Department of Human Services (DHS) Local Office contacts you near the end of one year to renew your coverage. See pages for more information on this. Changes To Report: You can report changes by phone, letter or in person. You must tell your DHS Local Office in 10 days if these changes happen. You move The MediPlan Card is not automatically forwarded with your other mail. Anyone who gets KidCare moves out of Illinois, dies, or goes to jail or prison Your children may get medical benefits longer if you tell your DHS Local Office when Your family s income goes down The number of family members living with you goes up You should also tell your DHS Local Office If your children s health insurance changes or they begin getting health insurance Someone in your family gets pregnant Medical Bills: There are no co-payments or premiums for KidCare Assist. If you get a bill while your children are covered by KidCare Assist, call the doctor or health care provider. Tell them you have KidCare Assist. Give them the information on your MediPlan Card. If you keep getting the bill, call your DHS Local Office or the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ). NOTE: You do not have to go to your DHS Local Office about your KidCare coverage. Everything can be handled by phone or mail. Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ) 7

10 KIDCARE - KEEPING YOUR KIDS HEALTHY KIDCARE MOMS & BABIES KidCare Moms & Babies Health Care For Pregnant Women And Their Babies Up To 12 Months Of Age Benefits: KidCare Moms & Babies pays for covered medical services. See Part 3 and Part 5 to learn how to get health care. Contact Office: I.D. Cards: Call your Department of Human Services (DHS) Local Office if you have questions about KidCare Moms & Babies. If you don t know the number, call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ). You get a new MediPlan Card every month. Keep the MediPlan Card. You must show it to doctors or health care providers when you or your baby get health care. Do not give the MediPlan Card to anyone. The MediPlan Card is printed on white paper. The front of the card lists the case I.D. number and dates the MediPlan Card covers. The back of the card gives the names and birth dates of all family members who get KidCare. An individual I.D. number is listed next to the name of each person. This number is used by doctors and health care providers to bill KidCare. Report any errors that you notice on the card to your DHS Local Office. See sample MediPlan Card on next page. If you lose your MediPlan Card or you do not get one at the beginning of the month, call your DHS Local Office. 8 Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: )

11 KIDCARE MOMS & BABIES KIDCARE - KEEPING YOUR KIDS HEALTHY Front of KidCare Moms & Babies MediPlan Card: State of Illinois - Department of Public Aid MediPlan Case ID Number Eligibility Period Doe, Jane R Through CASELOAD Z99 X IMAGINARY, JANE DOE 45 ANYPLACE ROAD YOUR TOWN, IL DPA 469 (R-1-90) IL Note: The seal of the State of Illinois appears in blue ink in the spot marked with a large X in a circle. Back of KidCare Moms & Babies MediPlan Card: Eligibility Period Through Case ID Number IMAGINARY, JANE DOE 45 ANYPLACE ROAD YOUR TOWN, IL Length Of ONLY THE FOLLOWING PERSONS ARE ELIGIBLE: JANE D. IMAGINARY ID#: DOB: 09/28/81 MEDICAID *********************************************************************** TOTAL NUMBER OF COVERED PERSONS: 1 x Please see front of card for important information- Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ) 9

12 KIDCARE - KEEPING YOUR KIDS HEALTHY KIDCARE MOMS & BABIES Length Of Coverage: Once approved, you are covered until two months after you are no longer pregnant. If you are pregnant and 18 or younger, coverage may continue for 12 months from the first month of coverage. If you are enrolled in KidCare when your baby is born, your baby receives KidCare health benefits for one year from the date of birth. See pages for more information on this. Changes To Report: You can report changes by phone, letter or in person. You must tell your Department of Human Services (DHS) Local Office in 10 days when and if these changes happen. You are no longer pregnant You move The MediPlan Card is not automatically forwarded with your other mail. Anyone who gets KidCare moves out of Illinois, dies, or goes to jail or prison You may get medical benefits longer if you tell your DHS Local Office when Your family s income goes down The number of family members living with you goes up You should tell your DHS Local Office if your or your baby s other health insurance changes. Remember, you should call your DHS Local Office or call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ) to report when the baby is born, the baby s name, whether it is a boy or girl, the date of birth and if the baby has any other health insurance. 10 Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: )

13 KIDCARE MOMS & BABIES KIDCARE - KEEPING YOUR KIDS HEALTHY Medical Bills: There are no co-payments or premiums for KidCare Moms & Babies. If you get a bill while you or your baby are covered by KidCare Moms & Babies, call the doctor or health care provider. Tell them you have KidCare Moms & Babies. Give them the information on your MediPlan Card. If you keep getting the bill, call your Department of Human Services (DHS) Local Office or the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ). NOTE: You do not have to go to your DHS Local Office about your KidCare coverage. Everything can be handled by phone or mail. Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ) 11

14 KIDCARE SHARE KidCare Share Health Care For Uninsured Children 18 Or Younger Benefits: KidCare Share covers a wide range of health care services. You pay a share of your children s health care costs because you pay copayments for some medical services. See Part 3 and Part 5 to learn how to get health care for your children. Contact Office: I.D. Cards: Call the central KidCare Unit in Springfield toll-free at if you have questions about KidCare Share. You get a new KidCare I.D. Card every month. Keep the KidCare I.D. Card. You must show it to doctors or health care providers when your children get health care. Do not give the KidCare I.D. Card to anyone. The KidCare I.D. Card is printed on yellow paper. The front of the card lists the case I.D. number, dates the KidCare I.D. Card covers and co-payments you must pay. The back of the card gives the names and birth dates of all children who get KidCare. An individual I.D. number is listed next to the name of each child. This number is used by doctors and health care providers to bill KidCare. Report any errors that you notice on the card to the central KidCare Unit. See sample KidCare Share I.D. Card on next page. If you lose your KidCare I.D. Card or you do not get one at the beginning of the month, call the central KidCare Unit. 12 Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: )

15 KIDCARE SHARE KIDCARE KEEPING YOUR KIDS HEALTHY Front of KidCare Share Insurance Card: State of More KidCare Information: Illinois Call OUR-KIDS F (TTY: ) Case ID Number Coverage Period W Through CASELOAD: 091. Doe, Jane RPY 123 Main Street Springfield, IL PROVIDERS MAY COLLECT A CO-PAY FOR CERTAIN SERVICES. CO-PAYS ARE $2.00 FOR DRUG PRESCRIPTION AND CERTAIN TYPES OF MEDICAL VISITS. NO CO-PAYS FOR IMMUNIZATIONS, WELL-CHILD VISITS, LAB AND RADIOLOGY SERVICES. DPA 469KC (R-7-98) KC IL Back of KidCare Share Insurance Card. Coverage Period Through DOE, JANE RPY 123 Main Street Springfield, IL Case ID Number: W99999 ADDRESS CHANGED? CALL OUR-KIDS B RIGHT AWAY (TTY: ) ONLY THE FOLLOWING PERSONS ARE COVERED BOBBY DOE ID#: DOB: 01/01/90 CINDY SMITH ID#: DOB: 01/01/92 ****************************************************************************** TOTAL NUMBER OF COVERED PERSONS: 2 KC Please see front of card for important information- Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ) 13

16 KIDCARE SHARE Length Of Coverage: KidCare Share may continue up to one year at a time. KidCare contacts you near the end of one year to renew your coverage. See pages for more information on this. Changes To Report: You can report changes by phone, letter or in person. You must tell the central KidCare Unit in 10 days when these changes happen. You move Anyone who gets KidCare moves out of Illinois, dies, or goes to jail or prison Any of your children begin getting insurance Your children may get medical benefits longer if you tell the central KidCare Unit when Your family s income goes down The number of family members living with you goes up You should also tell the central KidCare Unit when someone in your family gets pregnant. Call the central KidCare Unit in Springfield toll-free at to report changes. If you want to add children to KidCare, call the central KidCare Unit. Co-payments: You may be charged a co-payment at a doctor s or a health care provider s office when your children get health care. Co-payment amounts are $2.00 for each doctor, dentist or other health care visit when your children are sick $2.00 for each emergency room visit in an emergency and in a non-emergency $2.00 for each prescription There are no co-payments for well-child visits including visits for shots (vaccinations) and checkups for children. There are no copayments for lab tests or x-rays. 14 Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: )

17 KIDCARE SHARE KIDCARE KEEPING YOUR KIDS HEALTHY The doctor or health care provider may refuse to see your children if you don t pay your co-payment. Some doctors and health care providers do not charge co-payments. Families with children who are American Indians or Alaska Natives do not have to pay co-payments. You do not have to pay co-payments after you have paid $ in co-payments in a year for your children who are in KidCare Share or Premium. KidCare mailed a Co-payment Tracking Form to you to keep track of the co-payments you make. If you didn t get one, call the central KidCare Unit in Springfield toll-free at If your co-payments reach $ during the enrollment year, send your receipts to the central KidCare Unit in the Co-payment Tracking Form envelope. After the central KidCare Unit gets your receipts showing you paid $100 in co-payments, you get a letter showing that your copayment is now $0.00. Your next KidCare I.D. Card also shows $0.00 co-payment for the rest of your 12-month coverage period. Medical Bills: There are no premiums. If you get a bill while your children are covered by KidCare Share, call the doctor or health care provider. Tell them you have KidCare Share. Give them the information on your KidCare I.D. Card. If you keep getting the bill, call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ). If you have medical bills for your children before they were covered by KidCare that you want help with, see Prior Coverage on pages 24 and 25. Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ) 15

18 KIDCARE PREMIUM KidCare Premium Health Care For Uninsured Children 18 Or Younger Benefits: KidCare Premium covers a wide range of health care services. You pay a monthly premium for KidCare and you pay co-payments for some medical services. See Part 3 and Part 5 to learn how to get health care for your children. Contact Office: Call the central KidCare Unit in Springfield toll-free at if you have questions about KidCare Premium. I.D. Cards: You get a new KidCard I.D. Card every month. Keep the KidCare I.D. Card. You must show it to doctors or health care providers when your children get health care. Do not give the KidCare I.D. Card to anyone. The KidCare I.D. Card is printed on yellow paper. The front of the card lists the case I.D. number, dates the KidCare I.D. Card covers and co-payments you must pay. The back of the card gives the names and birth dates of all children who get KidCare. An individual I.D. number is listed next to the name of each child. This number is used by doctors and health care providers to bill KidCare. Report any errors that you notice on the card to the central KidCare Unit. See sample KidCare Premium I.D. Card on next page. If you lose your KidCare I.D. Card or you do not get one at the beginning of the month, call the central KidCare Unit. 16 Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: )

19 KIDCARE PREMIUM KIDCARE - KEEPING YOUR KIDS HEALTHY Front of KidCare Premium Insurance Card: F State of More KidCare Information: Illinois Call OUR-KIDS (TTY: ) Case ID Number Coverage Period W99999 Case ID Number Through Coverage Period CASELOAD: 091. Doe, Jane RPY 123 Main Street Springfield, IL PROVIDERS MAY COLLECT A CO-PAY FOR CERTAIN SERVICES. CO-PAYS ARE $5.00 FOR CERTAIN TYPES OF MEDICAL VISITS, $3.00 FOR GENERIC OR $5.00 FOR BRAND-NAME PRESCRIPTIONS, AND $25.00 FOR NON-EMERGANCY USE OF EMERGENCY ROOM. NO CO-PAYS FOR IMMUNIZATIONS, WELL-CHILD VISITS, LAB AND RADIOLOGY SERVICES. DPA 469KC (R-7-98) KC IL Back of KidCare Premium Insurance Card: Coverage Period Through DOE, JANE RPY 123 Main Street Springfield, IL Case ID Number W99999 ADDRESS CHANGED? CALL OUR-KIDS RIGHT AWAY (TTY: ) B ONLY THE FOLLOWING PERSONS ARE COVERED: BOBBY DOE ID#: DOB: 01/01/90 CINDY SMITH ID#: DOB: 01/01/92 ***************************************************************** TOTAL NUMBER OF COVERED PERSONS: 2 KC Please see front of card for important information- Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ) 17

20 KIDCARE - KEEPING YOUR KIDS HEALTHY KIDCARE PREMIUM Length Of Coverage: KidCare Premium may continue up to one year at a time. KidCare contacts you near the end of one year to renew your coverage. See pages for more information on this. Changes To Report: You can report changes by phone, letter or in person. You must tell the central KidCare Unit in 10 days when these changes happen. You move Anyone who gets KidCare moves out of Illinois, dies, or goes to jail or prison Any of your children begin getting insurance Your children may get medical benefits longer if you tell the central KidCare Unit when Your family s income goes down The number of family members living with you goes up You should also tell the central KidCare Unit when someone in your family gets pregnant. Call the central KidCare Unit in Springfield toll-free at to report changes. If you want to add children to KidCare, call the central KidCare Unit. Co-payments: You may be charged a co-payment at a doctor s or a health care provider s office when your children get health care. Co-payment amounts are $5.00 for each doctor, dentist or other health care visit when your children are sick $3.00 for each generic prescription $5.00 for each brand name prescription $25.00 for each emergency room visit in a non-emergency $5.00 for each emergency room visit in an emergency 18 Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: )

21 KIDCARE PREMIUM KIDCARE - KEEPING YOUR KIDS HEALTHY There are no co-payments for well-child visits including visits for shots (vaccinations) and checkups for children. There are no co-payments for lab tests or x-rays. The doctor or health care provider may refuse to see your children if you don t pay your co-payment. Some doctors and health care providers do not charge co-payments. Families with children who are American Indians or Alaska Natives do not have to pay co-payments. You do not have to pay co-payments after you have paid $ in copayments in a year for your children who are in KidCare Share or KidCare Premium. KidCare mailed a Co-payment Tracking Form to you to keep track of the co-payments you make. If you didn t get one, call the central KidCare Unit in Springfield toll-free at If your co-payments reach $ during the enrollment year, send your receipts to the central KidCare Unit in the Co-payment Tracking Form envelope. After the central KidCare Unit gets your receipts showing you paid $100 in co-payments, you get a letter showing that your copayment is now $0.00. Your next KidCare I.D. Card also shows $0.00 co-payment for the rest of your 12-month coverage. The most any KidCare family pays in a year is $460. ($100 in copayments, $360 in premiums for three or more children). Many families pay less. Monthly Premiums: With KidCare Premium, you pay a premium for your children each month even if your children do not need any health care. Monthly premiums are Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ) 19

22 KIDCARE - KEEPING YOUR KIDS HEALTHY KIDCARE PREMIUM One child - $15.00 Two children - $25.00 Three or more children - $30.00 Families with children who are American Indians or Alaska Natives do not have to pay premiums. Each month KidCare bills you for your premium. You need to pay each bill by the due date on the bill. It is important to pay premiums on time so that KidCare does not stop for your children. If you do not pay the premiums, KidCare will be cancelled. If your coverage is cancelled because you did not pay your premiums, you must wait three months before your children can again be enrolled in KidCare Share, KidCare Premium or KidCare Rebate. All past due premiums must be paid before your children can be enrolled again. You receive a notice to pay your premium each month. The notice tells how much you owe, when the payment is due and where to send the payment. Mail your payment to Bureau of Fiscal Operations, Department of Public Aid, P.O. Box 19121, Springfield, IL You can pay the premium by personal check, money order, Visa or MasterCard. If you want to use Visa or MasterCard, call the Bureau of Fiscal Operations toll-free at Medical Bills: If you get a bill while your children are covered by KidCare Premium, call the doctor or health care provider. Tell them you have KidCare Premium. Give them the information on your KidCare I.D. Card. If you keep getting the bill, call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ). If you have medical bills for your children before they were covered by KidCare that you want help with, see Prior Coverage on pages 24 and Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: )

23 KIDCARE REBATE KIDCARE - KEEPING YOUR KIDS HEALTHY KidCare Rebate Payments For Children 18 Or Younger With Health Insurance Benefits: KidCare pays the policyholder a rebate to cover some of the costs of the premiums for the children s insurance. The policyholder is the person to whom a health insurance policy covering a child is issued. KidCare Rebate can pay for some or all of the health insurance premiums you pay for your children. KidCare Rebate pays the policyholder up to $75.00 per child per month for their health insurance premium cost. The policyholder pays all premiums owed to an employer or insurance company for the children s coverage. The KidCare Rebate check is paid directly to the policyholder. Your children s health benefits are set by the employer or private health insurance plan. You can get KidCare Rebate only if the children s health insurance covers doctor and inpatient hospital care. You pay for any co-payments, co-insurance or deductibles charged by the employer or private health insurance plan. Contact Office: Call the central KidCare Unit in Springfield toll-free at if you have questions about KidCare Rebate. I.D. Cards: Use the I.D. Card from your insurance company. You do not get an I.D. Card from KidCare. Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ) 21

24 KIDCARE - KEEPING YOUR KIDS HEALTHY KIDCARE REBATE Length Of Coverage: KidCare Rebate may continue up to one year at a time. KidCare contacts you near the end of one year to renew your coverage. See pages for more information on this. Changes To Report: You can report changes by phone, letter or in person. You must tell the central KidCare Unit in 10 days when these changes happen. You move The Rebate check is not automatically forwarded with your other mail Anyone who gets benefits moves out of Illinois, dies, or goes to jail or prison Someone is added to or taken off the health insurance policy or the policyholder changes The monthly health insurance premium or insurance carrier changes Your children s health insurance plan ends If these changes are not reported within 10 days you may get an overpayment. You may be asked to pay back any overpayment. It may be helpful to you to call the central KidCare Unit if these changes happen. Your family s income goes down The number of family members living with you goes up You should call the central KidCare Unit when someone in your family gets pregnant. If you want to add children to KidCare, call the central KidCare Unit in Springfield toll-free at to report changes. 22 Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: )

25 KIDCARE REBATE KIDCARE - KEEPING YOUR KIDS HEALTHY If the policyholder gets Rebate checks for months when your children were not covered by health insurance, you must contact KidCare right away. (This is considered an overpayment. It must be repaid.) Payments: KidCare mails Rebate checks around the first of each month. You may go to the Illinois Office of the Comptroller s website at to check the mail date of your Rebate payment. Select Vendor Payments then follow the directions. If you have any questions about your Rebate payment, please call KidCare tollfree at If There Is A Problem: If you do not get your Rebate check, call the central KidCare Unit toll-free at The central KidCare Unit can help if you are having a problem with KidCare Rebate. Read Taking Care Of Problems, pages of this handbook and follow the directions. For all other problems you must refer to the policyholder s plan handbook, or speak to the benefits manager at the policyholder s job or speak to your insurance agent. Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ) 23

26 If You Had Medical Bills When You Applied For KidCare, You May Get Help To Pay Them! KidCare Assist And KidCare Moms & Babies: If you had medical bills for one of the three months before you applied for KidCare or for months while your application was with KidCare, you may be able to get help. Contact your Department of Human Services (DHS) Local Office caseworker for more information. If you don t know the number, call the KidCare hotline tollfree at OUR-KIDS ( ) (TTY: ). When you or your children are approved for coverage for KidCare Assist or KidCare Moms & Babies, the date that medical coverage begins is written in the approval letter that you get. When you or your children are approved for medical coverage, the first month of coverage can be one of the following: The month you applied, if you or your children were eligible for that month, or Up to three months before the month you applied, if you or your children were eligible for those months. KidCare Share And KidCare Premium: If you had medical bills for one of the two weeks before you applied for KidCare, you may be able to get help to pay them. 24 Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: )

27 Contact the central KidCare Unit in Springfield tollfree at for more information. When your children are approved for coverage for KidCare Share or KidCare Premium, the date that medical coverage begins is written in the approval letter that you get. The first time your children are approved for KidCare Share or KidCare Premium, the children may be eligible for payment of medical services received from two weeks before the date of application until the date KidCare coverage begins. This is called prior coverage. If you want prior coverage for your children, you must request it within six months from the beginning date of KidCare Share or KidCare Premium coverage. You may request prior coverage by calling the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ) or the central KidCare Unit in Springfield toll-free at You may also mail your request for prior coverage to the central KidCare Unit at P.O. Box Springfield, IL You may do this by using the KidCare form or sending a letter with your request. Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ) 25

28 Renewal KidCare Assist: At the end of one year you are contacted by your Department of Human Services (DHS) Local Office to review your children s eligibility to keep getting KidCare. See sample form, Your Family s Medical Eligibility,on the next two pages. It is important you give any information requested by your DHS Local Office. They need the information to decide if your children can still get KidCare Assist. Your DHS Local Office lets you know if your children qualify for another year of KidCare Assist or for a different KidCare plan. NOTE: If your DHS Local Office does not contact you, you remain on KidCare Assist until the renewal is completed. KidCare Moms & Babies: Pregnant Woman NOTE: You do not have to go to your DHS Local Office about your KidCare coverage. Everything can be handled by phone or mail. You must call your DHS Local Office to report when you are no longer pregnant. If you don t know the number, call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ). About two months after you are no longer pregnant, your DHS Local Office decides if you can get one of the other KidCare Plans. See sample form, Your Family s Medical Eligibility, on the next two pages. 26 Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: )

29 6(PERMANENT) Your Family s Medical Eligibility Redetermination Form (Category 94/96) DATE: Case Number: LO Name: Address: We have to check if your family can still get medical benefits. We need your help. You must fill out this form and send it back to us. You must also send copies of proof of: e your family s earned and unearned income for the last 30 days, and e spousal or child support paid by your family in the last 30 days. If you do not return this form and the copies we need by, your medical benefits will end. If you need more time to complete this form and get the proofs we need, be sure to call at before then. Current Home Phone #: Current Work Phone #: Fill in the blanks below for the people now on your MediPlan card if you still want to get medical benefits for them. Name Birth Date Health insurance other than Medicaid? Name Birth Date Health insurance other than Medicaid? 9 Yes 9 No 9 Yes 9 No 9 Yes 9 No 9 Yes 9 No 9 Yes 9 No 9 Yes 9 No 9 Yes 9 No 9 Yes 9 No Below list other people who live with you. Also list their relationship to you. Include yourself, your spouse, your children not listed above, parents of children listed above, and brothers and sisters of children listed above. If you need extra space, attach another sheet of paper. Name Birth Date Relationship Name Birth Date Relationship Is anyone listed on this form pregnant? 9 Yes 9 No. If yes, and you have not already done so, please provide a statement from a licensed medical provider with the name of the pregnant person, expected date of delivery and the number of babies expected. DPA 643 (R-9-01) IL Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ) 27

30 Is any adult or minor parent listed on this form currently employed? 9 Yes 9 No If yes, complete the following: Is anyone self-employed? 9 Yes 9 No Name of Person Employer Number of hours worked weekly Amount paid (before taxes) $ How often paid Name of Person Employer Number of hours worked weekly Amount paid (before taxes) $ How often paid ENCLOSE PAYSTUBS OR SELF-EMPLOYMENT RECORDS FOR ALL EMPLOYED PERSONS FOR THE LAST 30 DAYS Is anyone listed on this form RECEIVING money from any source other than employment (such as from social security, child support, rental property, unemployment benefits, pension, trusts, etc.)? 9Yes 9 No If yes, complete the following: Name of person Source Monthly Amount $ Name of person Source Monthly Amount $ ALSO ENCLOSE PROOF OF THIS INCOME FOR THE LAST 30 DAYS Is anyone listed on this form PAYING ordered spousal or child support? 9 Yes 9 No If yes, complete the following: Name of person Monthly Amount $ Name of person Monthly Amount $ ALSO ENCLOSE PROOF OF THIS PAYMENT FOR THE LAST 30 DAYS Is anyone listed on this form PAYING for day care so they can work? 9 Yes 9 No If yes, complete the following: Name of child(ren) in day care Name of Care Giver Person paying day care Monthly Amount $ Relationship of Care Giver to Child (if any) CHECK TO MAKE SURE YOU ANSWERED ALL THE QUESTIONS AND RETURNED THE NECESSARY PROOF Officials with responsibilities for the medical benefits program which I or the members of my household receive may verify all information on this form. I understand that I must cooperate in these efforts to verify information. I understand that verification may occur through electronic means. I understand that anyone who knowingly misuses the health benefits card issued by the State of Illinois may be committing a crime. I understand that if I have given false information or intentionally failed to disclose information for this application, I may be subject to criminal prosecution, civil action or both. I certify under the penalty of perjury that the information I have provided on this application form is the truth to the best of my knowledge. Signature Today s Date 28 Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: )

31 It is important you give any information requested by your Department of Human Services (DHS) Local Office. They need the information to decide if you can still get KidCare. NOTE: If your DHS Local Office does not contact you, you remain on KidCare Moms & Babies until the renewal is completed. NOTE: You do not have to go to your DHS Local Office about your KidCare coverage. Everything can be handled by phone or mail. New Baby After the baby is one year old, you are contacted by your DHS Local Office to decide if your baby can get one of the other KidCare Plans. See sample form, Your Family s Medical Eligibility, on the next two pages. It is important that you give any information requested by your DHS Local Office. They need the information to decide if your baby can get another KidCare Plan. Your DHS Local Office lets you know if your baby can get another KidCare Plan. NOTE: If your DHS Local Office does not contact you, your baby remains on KidCare Moms & Babies until the renewal is completed. NOTE: You do not have to go to your DHS Local Office about your KidCare coverage. Everything can be handled by phone or mail. Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ) 29

32 6(PERMANENT) Your Family s Medical Eligibility Redetermination Form (Category 94/96) DATE: Case Number: LO Name: Address: We have to check if your family can still get medical benefits. We need your help. You must fill out this form and send it back to us. You must also send copies of proof of: e your family s earned and unearned income for the last 30 days, and e spousal or child support paid by your family in the last 30 days. If you do not return this form and the copies we need by, your medical benefits will end. If you need more time to complete this form and get the proofs we need, be sure to call at before then. Current Home Phone #: Current Work Phone #: Fill in the blanks below for the people now on your MediPlan card if you still want to get medical benefits for them. Name Birth Date Health insurance other than Medicaid? Name Birth Date Health insurance other than Medicaid? 9 Yes 9 No 9 Yes 9 No 9 Yes 9 No 9 Yes 9 No 9 Yes 9 No 9 Yes 9 No 9 Yes 9 No 9 Yes 9 No Below list other people who live with you. Also list their relationship to you. Include yourself, your spouse, your children not listed above, parents of children listed above, and brothers and sisters of children listed above. If you need extra space, attach another sheet of paper. Name Birth Date Relationship Name Birth Date Relationship Is anyone listed on this form pregnant? 9 Yes 9 No. If yes, and you have not already done so, please provide a statement from a licensed medical provider with the name of the pregnant person, expected date of delivery and the number of babies expected. DPA 643 (R-9-01) IL Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: )

33 Is any adult or minor parent listed on this form currently employed? 9 Yes 9 No If yes, complete the following: Is anyone self-employed? 9 Yes 9 No Name of Person Employer Number of hours worked weekly Amount paid (before taxes) $ How often paid Name of Person Employer Number of hours worked weekly Amount paid (before taxes) $ How often paid ENCLOSE PAYSTUBS OR SELF-EMPLOYMENT RECORDS FOR ALL EMPLOYED PERSONS FOR THE LAST 30 DAYS Is anyone listed on this form RECEIVING money from any source other than employment (such as from social security, child support, rental property, unemployment benefits, pension, trusts, etc.)? 9Yes 9 No If yes, complete the following: Name of person Source Monthly Amount $ Name of person Source Monthly Amount $ ALSO ENCLOSE PROOF OF THIS INCOME FOR THE LAST 30 DAYS Is anyone listed on this form PAYING ordered spousal or child support? 9 Yes 9 No If yes, complete the following: Name of person Monthly Amount $ Name of person Monthly Amount $ ALSO ENCLOSE PROOF OF THIS PAYMENT FOR THE LAST 30 DAYS Is anyone listed on this form PAYING for day care so they can work? 9 Yes 9 No If yes, complete the following: Name of child(ren) in day care Name of Care Giver Person paying day care Monthly Amount $ Relationship of Care Giver to Child (if any) CHECK TO MAKE SURE YOU ANSWERED ALL THE QUESTIONS AND RETURNED THE NECESSARY PROOF Officials with responsibilities for the medical benefits program which I or the members of my household receive may verify all information on this form. I understand that I must cooperate in these efforts to verify information. I understand that verification may occur through electronic means. I understand that anyone who knowingly misuses the health benefits card issued by the State of Illinois may be committing a crime. I understand that if I have given false information or intentionally failed to disclose information for this application, I may be subject to criminal prosecution, civil action or both. I certify under the penalty of perjury that the information I have provided on this application form is the truth to the best of my knowledge. Signature Today s Date Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ) 31

34 KidCare Share KidCare Premium KidCare Rebate: The renewal process for KidCare Share, KidCare Premium and KidCare Rebate is the same. Near the end of the one-year coverage period, you get a renewal form in the mail. KidCare uses this form to decide if your children can still get KidCare. See sample form, Renewal of Eligibility, on the next two pages. Complete and return the form. It is important you give any information requested by the central KidCare Unit. KidCare needs this information to decide if your children can stay in KidCare. The central KidCare Unit lets you know if your children qualify for another year of KidCare Share, KidCare Premium, KidCare Rebate or if they qualify for a different KidCare Plan. NOTE: If you do not get a renewal form by the 11 th month of coverage, call the central KidCare Unit in Springfield tollfree at Coverage ends after the 12th month if the renewal process is not completed. 32 Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: )

35 RENEWAL OF ELIGIBILITY April 23, 2002 KidCare Unit P. O. Box Springfield, IL KidCare #: Your children s eligibility for KidCare must be renewed once a year. You must complete this form and return proof of your family s income (earned and unearned), and court-ordered spousal and /or child support paid. Please return this information by to ensure that your children's benefits will continue without interruption. You must also return the completed and signed Rebate form with this form. Please type or print in ink. If more space is needed to answer any question, please attach an extra sheet. Is the above still your mailing address? Yes No. If no, what is your new mailing address? New Address Phone Number Following are the names of the children for whom you are receiving KidCare. Check whether or not they still live with you and whether or not they have health insurance. Do they Name of Child Birth Date Do they still live with you? have health insurance other than KidCare? Yes No If no, when did they move out? Yes No Yes No If no, when did they move out? Yes No Yes No If no, when did they move out? Yes No Yes No If no, when did they move out? Yes No Yes No If no, when did they move out? Yes No Yes No If no, when did they move out? Yes No Yes No If no, when did they move out? Yes No List the following persons not listed above who also live with you. Also list their relationship to you. Include yourself, your spouse, children not listed above, legal parents of children listed above, and siblings of children listed above. If you need extra space, attach another sheet of paper. Name Relationship Date of Birth Name Relationship Date of Birth 1. Self KC 643KC (R-8-00) KC Rep # IL Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ) 33

36 Is anyone listed on this form pregnant? Yes No. If yes, please provide a statement from a licensed medical provider with the name of the pregnant person, expected date of delivery and the number of births. Is any parent, step-parent or spouse listed on this from currently employed? Yes No If yes, complete the following: Is anyone self-employed? Yes No Name of Person Employer Employer Address Employer Phone Number of hours worked weekly Amount paid (before taxes) $ How often paid Name of Person Employer Employer Address Employer Phone Number of hours worked weekly Amount paid (before taxes) $ How often paid ENCLOSE PAYSTUBS OR SELF-EMPLOYMENT RECORDS FOR ALL EMPLOYED PERSONS FOR THE LAST 30 DAYS Is anyone listed on this form RECEIVING money from any source other than employment (such as from social security, child support, rental property, unemployment benefits, pension, trusts)? Yes No If yes, complete the following: Name of person Source Monthly Amount $ Name of person Source Monthly Amount $ ALSO ENCLOSE PROOF OF THIS INCOME FOR THE LAST 30 DAYS Is any parent, step-parent or spouse listed on this form PAYING ordered spousal or child support? Yes No If yes, complete the following: Name of person Monthly Amount $ Name of person Monthly Amount $ ALSO ENCLOSE PROOF OF THIS PAYMENT FOR THE LAST 30 DAYS Is any parent, step-parent or spouse listed on this form PAYING for day care so they can work? Yes No If yes, complete the following: Name of child(ren) in day care Name of Care Giver Person paying day care Monthly Amount $ Relationship of Care Giver to Child (if any) Check to make sure you answered all the questions and returned the necessary proofs. Officials with responsibilities for the health benefits program for which I or the members of my household are receiving may verify all information on this form. I understand that I must cooperate in these efforts to verify information. I understand that verification may occur through electronic means. I understand that anyone who knowingly lies or misrepresents the truth or arranges for someone to knowingly lie or misrepresent the truth or intentionally misuses the health benefits card issued by the State of Illinois may be committing a crime which can be prosecuted or punished under federal law, state law or both. I certify under penalty of perjury that the information I have provided on this application form is the truth to the best of my knowledge. Signature 34 Today s Date If you have any questions, please call us at Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: )

37 PART 3. KIDCARE SERVICES TO KEEP HEALTHY The KidCare Advantage: KidCare covers most medical services pregnant women and children need. KidCare serves you better if you Choose a doctor See the doctor when you or your children are sick See the doctor for checkups when you or your children are feeling good. This is called preventive health care. Personal Doctor: It is important to get a personal doctor and to use the same personal doctor as much as possible for your health care needs. A personal doctor Helps you get care for your children Provides care when your children are sick Knows your medical history and your children s medical history Keeps track of your children s shots (vaccinations) Can give you advice Refers you to a specialist when needed Helps pregnant women deliver healthy babies Answers some of your questions over the phone Can help you avoid the emergency room Keep your personal doctor s phone number handy. Preventive Health Care: KidCare preventive medical services Help your children stay healthy Help your children get all the exams and shots (vaccinations) they need Help you stay healthy if you are pregnant Help you have a healthy baby Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ) 35

38 KidCare Medical Services KidCare Assist, KidCare Moms & Babies, KidCare Share And KidCare Premium pay for the following medical services Doctor services Care at health clinics Inpatient and outpatient hospital care Prescription drugs Dental care Vision (eye) care Laboratory tests & x-rays Transportation to medical care Family planning and birth control Medical equipment & supplies Help for alcohol & substance abuse Psychiatric and mental health care Hearing testing Chiropractic care Podiatric (feet) care Physical therapy Occupational therapy Speech therapy Home and special nursing care Kidney dialysis Nursing home care Hospice care Remember, these medical services are covered when you need them if the medical provider accepts your MediPlan or KidCare I.D. Card. Some services have to be approved ahead of time. Your doctor takes care of this. If you don t know if a service is covered, ask your doctor or call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ). In KidCare Rebate, your children s health benefits and medical services are set by the employer or private health insurance plan. 36 Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: )

39 Checkup Visits: Checkups are important, even when children are healthy. Your children s personal doctor answers questions and gives your children Health exams Tests, such as vision, hearing and lab services Shots (vaccinations) Medical referrals to specialists, if needed Your children s personal doctor will review your children s health and family history and your children s growth and development. For each visit be sure to bring Your MediPlan or KidCare I.D. Card Your I.D. Card from your employer or private health insurance plan if you have one Your managed care card if your children are enrolled with a managed care health plan Your children s health and shot (vaccination) record A list of medicines your children are taking The Department of Public Health recommends that children and teenagers get a checkup at each age listed below or more frequently as recommended by the doctor. 2 weeks old 15 months old Between age 6 and 8 1 month old 18 months old Between age 8 and 10 2 months old 24 months old Between age 10 and 12 4 months old Between age 2 and 3 Between age 12 and 14 6 months old Between age 3 and 4 Between age 14 and 16 9 months old Between age 4 and 5 Between age 16 and months old Between age 5 and 6 Between age 18 and 21 Also, be sure your child gets a lead screening by age 1 (12 months). Use the chart on page 78 to keep a record of your children s checkups. Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ) 37

40 Children And Their Shots: KIDCARE KEEPING YOUR KIDS HEALTHY Recommended by the Illinois Department of Public Health. This chart shows the childhood shots that all children should get and the age when they should get them. AGE SHOTS Birth - 2 Months Hepatitis B (Hep B) 1-4 Months Hep B 2 Months Diphtheria,Tetanus & Acellular Pertussis (DTaP) Polio (IPV) Haemophilus influenzae type b (Hib) Pneumococcal conjugate (PCV) 4 Months DTaP, IPV, Hib, PCV 6 Months DTaP, Hib, PCV 6-18 Months Hep B, IPV Months Hib Measles, Mumps & Rubella (MMR) PCV Months Varicella (chicken pox) Months DTaP 4 6 Years DTaP, IPV, MMR Years. Tetanus and diphtheria toxoid (Td) MMR (any age for children who have not yet had the second dose of MMR at 4-6 years) Varicella (for children who have not been given a shot for chicken pox and who have not had chicken pox) See your children s doctor or clinic if you think your children may have missed any of these shots. Use the chart on page 77 to keep a record of your children s shots. 38 Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: )

41 Dental Services: KidCare Dental Services For Children Oral exams Cleanings Topical fluoride Sealants Fillings Root canals Treatment of gum disease Dentures Extractions Braces when the dentist decides they are medically necessary Dental Services For Pregnant Women KidCare covers some dental care for pregnant women over age 20 For more information, call the toll-free numbers listed below To find out if a service is covered, call Doral Dental Services at (TTY: ) or the KidCare hotline at OUR-KIDS ( ) (TTY: ). Dentists To get dental services, make an appointment with a dentist who accepts KidCare. Call Doral Dental Services at for help finding a dentist. Recommended Dental Checkups By the ADA (The American Dental Association) For Children Age 1 And Older Oral Exam once every 12 months Cleaning once every 6 months Topical fluoride once every 12 months Sealants once per lifetime for 1 st and 2 nd molars Space maintainers prior approval needed If your children have problems with teeth, gums or mouth before the age of one year, take them to a dentist who treats KidCare families right away. Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ) 39

42 Vision (Eye) Services: KidCare covers Eye exams Eyeglasses A second pair of eyeglasses, if glasses are lost, broken or medically necessary Only certain eyeglass frames To get vision care, make an appointment with an eye doctor who treats KidCare families. For help in finding an eye doctor who accepts the MediPlan or KidCare I.D. Cards, call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ). How To Get Help You Need: To find out if a medical service is covered by KidCare Ask your doctor Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ) if more help is needed To find a doctor or specialist Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ) to get the names of doctors or clinics in your area who see KidCare patients Call the doctor s office to find out if they will see you or your children If you need help with medical equipment or medicines that require approval by KidCare, see your personal doctor. 40 Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: )

43 Services For Children With Special Health Care Needs: Your children can get help from KidCare for special health care problems. Do your children go to the doctor or hospital more often than other children you know? If the answer is yes, your children might need special services. Children might need special services if they Are slow to walk, talk or do things for themselves Have an ongoing illness like asthma or diabetes Are born with a problem like a heart defect or Down Syndrome Are deaf or blind Have problems with behavior (behave badly a lot) Have problems with emotions (are sad or angry a lot) Have trouble paying attention in school Have trouble making friends Have problems with talking, understanding or reading If your children have any of these problems, talk to your doctor. The doctor can tell you if your children need special services and can help you get them. With KidCare, your children can get many special services if they need them. Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ) 41

44 Early Intervention Children under age three can get early intervention services. Early intervention means finding a problem early and making sure that your children get special services to help with the problem. There are many special services to help children under three years old. To find out if your children can get these services, call Special Education Children over age three can get many special services from their schools. These services help children with many different kinds of problems. Some of these are behavior, speech, learning and reading problems. There are many other special services that children can get from schools. If your children are in school, talk to the teacher or social worker about special services. If your children are too young for school, they still might be able to get special services. Call your school district and ask for a pre-school screening. The school will tell you when a screening can be scheduled. 42 Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: )

45 Other Special Services Children may need other special services that they can t get with KidCare. You can call the places below to see if your children can get special services from them. Department of Human Services (DHS) Office of Rehabilitation Services (ORS) DHS/ORS offers services to people who are disabled, including people with physical disabilities and people who are blind or deaf. Services: Phone Number: Website: Vocational training, educational programs, advocacy, information and referral (Voice and TTY) University of Illinois Division of Specialized Care For Children (DSCC) DSCC offers services to children who have problems associated with certain physical disabilities. These include problems with bones, muscles, spinal cord, brain, heart, mouth, nose, hearing, speech, eye muscles, kidney, bladder, metabolism, and children with cystic fibrosis or hemophilia. Services: Care coordination and financial assistance. Phone Number: (Voice and TTY) Website: Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ) 43

46 PART 4. KIDCARE FOR PREGNANT WOMEN Health Care Right Away! KidCare has a special program for pregnant women. This program allows pregnant women to get health care right away, even before their KidCare Mom & Babies application is approved. This temporary coverage is called Medicaid Presumptive Eligibility (MPE). If someone in your family who is not enrolled in KidCare gets pregnant, call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ) to locate an MPE provider who gives prenatal exams and helps pregnant women apply for KidCare Moms & Babies Plan. If a person already enrolled in KidCare becomes pregnant, call your Department of Human Services (DHS) Local Office or the central KidCare Unit in Springfield toll-free at If You Think You Are Pregnant: See a doctor right away. Prenatal Care: Prenatal care is the health care that a doctor or clinic gives to pregnant women. It is important for you to get early prenatal care. If you go to the doctor as soon as you think you are pregnant and you keep going throughout your pregnancy, you and your baby have a better chance to stay healthy. Prenatal care should continue the whole time you are pregnant. 44 Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: )

47 You should receive prenatal care as often as your doctor or clinic recommends. The American Academy of Family Physicians and the American College of Obstetricians and Gynecologists recommend prenatal care visits take place at least Once every four weeks during the first six months of being pregnant Once every two weeks during the seventh and eighth months of being pregnant Once every week during the last month of being pregnant Or more often as directed by the doctor. For help in finding a doctor or clinic for prenatal care, call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ). What To Expect At Your Prenatal Care Visits: According to The American College of Obstetrics and Gynecology Standards of Care, you can expect the following at your prenatal visits. Your first prenatal care visit starts with a doctor asking questions about you and your health. Your doctor also gives you a physical exam, including Blood pressure and temperature checks Weight and height recording Mouth and teeth exam Breast exam Heart and lung exam Internal vaginal (pelvic) exam Pap smear Blood and urine tests Counseling and voluntary, confidential testing for HIV Counseling on the importance of prenatal vitamins Counseling about what to expect during your pregnancy including danger signs, a healthy diet and health risktaking behaviors Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ) 45

48 Ask questions! Make a list of questions to take with you to your appointment. The prenatal visit is for you. Later in your pregnancy your doctor will check your health to see if you and your baby are healthy. Later prenatal visits include: Weight and blood pressure checks Measuring the baby s growth Checking the baby s heart rate Special tests you may need to find out about your health or the health of your baby Physical exams as needed Dental Care: It is important to get dental care while you are pregnant. Call Doral Dental Services of Illinois toll-free at (TTY: ) for help in finding a dentist. Be Healthy While You Are Pregnant: Tips For Being Healthy While You Are Pregnant See a doctor or clinic as soon as you think you are pregnant. Keep all prenatal appointments with your doctor or health care provider. Don t smoke, drink alcohol or use street drugs; they can hurt you and your baby. Exercise regularly. Wear a seatbelt. Don t take any medicine, even an aspirin, without asking your doctor if it is safe. Read the label for directions and warnings before you use paint, bug spray, cleaner or other chemicals. Tell your doctor and your dentist that you are pregnant before you get any x-rays. Share your feelings, whether you are excited, scared, nervous or happy, with friends, family and doctor. 46 Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: )

49 Eat healthy foods. You may want to follow the Illinois WIC* Program Recommended Daily Food Guide and include in your diet: Milk and milk products (cheese, yogurt, cottage cheese) Protein foods (lean meat, eggs, peanut butter, beans, chicken, fish) Grain products (breads, pasta, dried beans, rice, corn tortillas) Fruits and vegetables Water, drink 6-8 glasses each day *Special Supplemental Food Program For Women, Infants and Children (WIC) You may need to eat smaller meals and more meals during the day. It is important to gain some weight while you are pregnant. Talk to your doctor about how much weight you should gain. Pregnant KidCare members are eligible for the WIC Program. WIC helps you learn how to eat healthy. WIC gives you coupons for free healthy food for you and your baby. See pages 56 and 57 for more information about WIC and other programs. Remember: Follow your doctor s medical advice. Work with your doctor to choose a hospital before your baby is born so that your medical records are there before you and your baby arrive. Choose a doctor or clinic for your baby. Call your doctor or clinic to make sure they will see your baby. The doctor or clinic will usually want to see your baby two weeks after the baby is born. (The doctor or clinic that gives you prenatal care will usually deliver your baby.) Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ) 47

50 Warnings Signs During Pregnancy: Be sure to talk about all of your worries with your doctor. It is important to see your doctor often and regularly. Keep all the appointments the doctor recommends. If there is a problem, your doctor may be able to treat you before it gets serious. Call your doctor right away if you see any of these signs Bleeding from your vagina Swelling or puffiness of your face, feet or hands Severe swelling of your legs Sudden large weight gain Spots or flashes of light before your eyes; dim or blurry vision Dizziness, headaches Sharp pain in your stomach or pain that won t go away Vomiting (throwing up) that won t stop Chills and fever Sudden gush or leaking of fluid from your vagina Pain, burning when going to the bathroom or having a hard time going to the bathroom Constant low back pain and pressure on your vagina Low stomach pain or cramping that comes and goes before the last month of your pregnancy After the 5 th month of pregnancy, less movement of your baby After your baby is born, you should have a checkup (post-partum visit). This usually is done about 4-6 weeks after your baby is born or whenever your doctor recommends. 48 Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: )

51 Your Baby Will Get KidCare For At Least One Year: If you are enrolled in KidCare when your baby is born, your baby will receive KidCare health benefits for at least one year as long as the baby lives in Illinois. You must call your caseworker or KidCare to let them know when your baby is born. Some hospitals will tell your Department of Human Services (DHS) Local Office or KidCare for you. Ask the hospital to do this. Your caseworker or KidCare needs to know Your name Your baby s name Whether your baby is a boy or girl Your baby s date of birth The case number on your MediPlan or KidCare I.D. Card Whether your baby has any other health insurance When you give your caseworker or KidCare this information about your baby, the baby is added to your KidCare coverage. Sometimes your baby gets his or her own MediPlan or KidCare I.D. Card. After the baby is one year old, you will be contacted by your DHS Local Office to decide if your baby can get one of the other KidCare Plans. If you do not know how to reach your caseworker or KidCare, call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ). As soon as your baby is born, start regular health care for your baby. Call the baby s doctor right away to make an appointment for your baby s checkup. Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ) 49

52 PART 5. USING YOUR KIDCARE BENEFITS Find A Personal Doctor: A Personal Doctor is a health professional whom you routinely see for all medical reasons and who knows you and your children. You might see your personal doctor at A doctor s office A clinic A hospital clinic A community health center Getting A Personal Doctor Involves Calling the doctor s office and asking whether the doctor sees KidCare patients Telling the doctor s office that you or your children want to become a patient Making an appointment for you or your children Making an appointment when you think you are pregnant Personal Doctor For Children Should be a pediatrician (children s doctor), a family doctor or a general practice doctor Will arrange for another doctor to see your children if necessary Will coordinate your children s health care Personal Doctor For Pregnant Women Should be an obstetrician (doctor who provides prenatal care), a family doctor, a general practice doctor or a doctor of internal medicine Will provide prenatal care Will coordinate health care while you are pregnant 50 Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: )

53 Specialists: A specialist is a doctor who treats special medical conditions. You should see or talk to your children s personal doctor about medical problems first. If your doctor thinks your children need to see a specialist, your doctor refers you to one. If you are in managed care (Americaid, Harmony Health Plan, Humana Health Plan, United Health Care of Illinois, Family Health Network), you have to follow the rules of the plan. See page 59. Your children s personal doctor may give the specialist medical information about your children to avoid repeating tests or treatment. Immediate Care Or Urgent Care: Most of the time, you should plan ahead and make an appointment for your children to see the doctor. Sometimes your children cannot wait a long time to see a doctor but it is not an emergency. Call your doctor right away for problems like Bad sunburn Sore throat Muscle sprains Earaches If you have a personal doctor, you can usually get care quickly if you need it. If you do not have a personal doctor, call the emergency number of your hospital and ask to speak to a doctor or nurse. Ask them for advice. Emergency Care: Go to the Emergency Room for emergencies. A medical emergency needs to be taken care of right away. An emergency is a medical condition that could cause death or serious harm to the person or unborn child if it is not treated right away. Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ) 51

54 IF YOU DO NOT KNOW IF AN ILLNESS IS A REAL EMERGENCY, GO TO THE NEAREST EMERGENCY ROOM. Examples of medical emergencies include but are not limited to Chest pains Severe bleeding Severe burns Loss of consciousness Difficulty breathing Seizures Broken bones Damage to eyes High fever Extreme pain in stomach Family Planning: Family planning helps you plan how many children you have and when you have them. Your doctor can give prescriptions for birth control pills and other supplies to help you plan when to get pregnant. A doctor or nurse can talk to you about how to plan a healthy pregnancy. If you need help getting family planning services, call the Help Me Grow Futures for Kids Help Line at (Voice and TTY). 52 Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: )

55 Transportation To Medical Care: Managed Care If you or your children cannot get a ride to the doctor, dentist or other medical provider, KidCare may pay for you or your children to get a ride. If you are in a managed care plan (Americaid, Harmony Health Plan, Humana Health Plan, United Health Care of Illinois, Family Health Network), call your managed care plan for approval of non-emergency or urgent medical transportation. If you are not in a managed care plan, read your choices below. Cook County In Cook County for approval of non-emergency or urgent medical transportation, call DynTek Services, Inc. (DynTek) toll-free at (TTY: ). DynTek must get your call at least two business days before you need a ride. Do not call more than seven business days before the day when you need a ride. (Business days mean Monday through Friday. Saturday, Sunday and holidays are not business days.) Call between 8:00 a.m. and 5:00 p.m. Monday through Friday. All Other Counties In ALL OTHER COUNTIES for approval of non-emergency or urgent medical transportation Call your Department of Human Services (DHS) Local Office if you or your children get KidCare Assist or KidCare Moms & Babies. If you don t know the number, call the KidCare hotline toll-free number at OUR-KIDS ( ) (TTY: ). Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ) 53

56 Call the central KidCare Unit in Springfield toll-free at if your children get KidCare Share or KidCare Premium When you call DynTek, your DHS Local Office or the central KidCare Unit, you may schedule more than one visit at a time. When you call for non-emergency or urgent medical transportation, you may need to answer these questions Name, address and phone number of the person who needs a ride The person s I.D. number from the MediPlan or KidCare I.D. Card Name of the doctor, dentist, clinic or lab that you are going to Address and phone number of the doctor, dentist, clinic or lab Date, time and reason for appointment Time you will need to be picked up In an EMERGENCY, call 911 or your local emergency number Or Go to the nearest hospital or place for emergency care, such as a health clinic Or Call your local ambulance company 54 Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: )

57 Mental Health & Substance Abuse: Mental Health Services include Assessment or Evaluation Emergency Care and Help in a Crisis Inpatient Psychiatric Care for children in a general or psychiatric hospital Nursing Facility Care Therapy, Counseling, Other Services -Outpatient hospital/psychiatric clinics -Laboratory and x-ray services -Doctors -Prescription drugs -Counseling by a doctor or at a community mental health center or at a hospital -Group therapy Substance Abuse Services include: * Psychiatric evaluation Individual or group outpatient counseling Detox in a hospital Residential rehabilitation for youth Day treatment *Some services are time-limited for adults but not for children. For help with Mental Health or Substance Abuse start by calling your personal doctor. You can also call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ). In an EMERGENCY, call 911 or your local emergency number. Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ) 55

58 Part 6. Other Services And Benefits Family Case Management: If you are pregnant or have a baby under age one, you can get Family Case Management. Case management may also be called service coordination, care coordination, family support or social work. A Family Case Manager will Tell you about your baby s health needs Help you learn how to stay healthy while you are pregnant Help you and your baby get health care Help you get services like WIC (see below) housing or child care To find out more about this program, call the toll-free Help Me Grow Futures for Kids Help Line at (Voice and TTY). WIC: WIC helps mothers, babies and children younger than age five get the healthy foods they need. WIC Teaches how to eat healthy Provides breast-feeding support Gives coupons for healthy foods such as milk, eggs, cheese, juice, cereal, dry beans or peas Gives coupons for infant formula for babies Helps with referrals to other services You may be able to get WIC if you Are pregnant or had a baby within the past six months Are breast-feeding and your baby is younger than one Have an infant or children younger than five years of age 56 Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: )

59 Parents, legal guardians or caretakers of infants or children under age five may apply for WIC. (You do not need to have proof of citizenship or immigration.) To find out more about WIC and the clinic nearest you, call the toll-free Help Me Grow Futures for Kids Help Line at , (Voice and TTY). Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ) 57

60 Child Support: The Child Support Program Can help to establish a legal father for your child if you were not married to the father when your child was conceived or born. Can collect child support payments or medical support payments for your child. If your child gets a MediPlan Card under KidCare Assist or KidCare Moms & Babies and both parents are not living in the home with the child You may get a notice in the mail from a Child Support representative. You will need to cooperate unless you have good reason not to. Your child s KidCare will not be affected, even if you do not cooperate. Call the phone number on the letter or (TTY: ) to find out more about this. If you get a letter from the state telling you about Child Support Read the letter carefully. Send any information requested. It is important that you keep all scheduled appointments. If you cannot keep the appointment, call the phone number on the letter or you can call (TTY: ). If your child is enrolled in KidCare Share, KidCare Premium, or KidCare Rebate You will not be contacted by Child Support. You may still call the number above if you want help with your child support. For more information about the Child Support Program, call (TTY: ) or go to the following website: 58 Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: )

61 PART 7. HOW TO GET MEDICAL CARE KidCare Has Two Ways To Help You Get Medical Care: You choose your own doctor or health care provider each time you need care. You should find a doctor who takes KidCare. You can go to many different health care providers but you should find them yourself. You have to check whether they take KidCare. You can change doctors anytime but KidCare recommends that you choose one doctor. The KidCare hotline can help you find doctors near you. Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ). Each time a doctor or health care provider treats your children, the provider sends KidCare a bill. Another way to get health care is through a managed care plan (Americaid, Harmony Health Plan, Humana Health Plan, United Health Care of Illinois, Family Health Network). Call your managed care plan. It gives you a list of doctors and other health care providers you can use. Your managed care plan gives you a member handbook that tells you how to get health care from the plan. You can join managed care if you are enrolled in KidCare Assist, KidCare Moms &Babies, KidCare Share or KidCare Premium. You also have to live in Cook County, St. Clair County or Madison County. KidCare pays the managed care plan. The managed care plan pays the doctors and other health care providers who care for your children. THE MEDICAL SERVICES ARE THE SAME WHETHER YOU CHOOSE YOUR OWN DOCTOR OR HEALTH CARE PROVIDER OR YOU ARE IN A MANAGED CARE PLAN. Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ) 59

62 PART 8. TAKING CARE OF PROBLEMS Complaints About Medical Providers: A Doctor Or Medical Provider You Selected If you have problems with a doctor or medical provider you selected, you may be able to work things out by talking to the doctor or medical provider or their staff. If that does not help, you may wish to find another doctor or medical provider. You can call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ) for help in changing doctors or medical providers, for reporting bad health care treatment by your doctor or medical provider and for complaints about medical bills. You might want to give information about your problem to the hotline representative, so that your problem can be referred to the right person. For example, if you have a problem with a medical billing the hotline can refer you to the medical field representative. A Doctor Or Medical Provider From Your Managed Care Plan If you have a managed care plan (Americaid, Harmony Health Plan, Humana Health Plan, United Health Care of Illinois, Family Health Network), and have a problem with a doctor or medical provider, call the member services department of your managed care plan To ask a question To discuss a complaint To change doctors 60 Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: )

63 If you are in a managed care plan, you can file a formal grievance (complaint) by following the directions in your managed care plan s member handbook. If you are in a managed care plan, you may appeal a decision About your health care That refuses to pay a medical bill you have If you cannot get problems resolved, you may call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ). The directions for filing appeals are in your managed care plan s member handbook. Complaints About KidCare Staff Or Your Local Office Staff: If you have a complaint about the conduct of a KidCare representative or Department of Human Services (DHS) Local Office staff, you should first ask to talk to a supervisor. If your complaint is not taken care of, you may file a grievance. Information about filing a grievance can be found on pages 66 and 67. Complaints About Cancellation Or Change In Coverage: KidCare sends you a written notice of cancellation of coverage and a written notice of any change in your benefits. If you have questions or complaints about a cancellation of your coverage or a change in your coverage, first call the phone number on the notice. Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ) 61

64 If the matter is not taken care of, you may ask for a hearing. See Appeals and Fair Hearings below. Appeals & Fair Hearings: If KidCare cancels, denies or changes your benefits, you have a right to appeal and to a fair hearing. You may appeal any decision made by KidCare or a Department of Human Services (DHS) Local Office that you think is wrong. You must file or start your appeal within 60 days of the date of a notice about your medical benefits. Some Actions You May Appeal: If you receive or have applied for KidCare, you can appeal any decision the central KidCare Unit in Springfield or a DHS Local Office makes about your case that you think is wrong. You can appeal if Your application is denied. Your benefits are stopped. Your benefits are reduced. Your benefits are changed---kidcare changes the amount of premium or co-payment or the amount of insurance rebate given. You disagree with a decision made about a medical service or item that needs special approval. You think a decision made is wrong. You think our failure to make a decision or delay in making a decision is wrong. How to ask for an appeal Write a letter requesting a hearing. Be sure to sign your letter. OR 62 Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: )

65 Fill out a Notice of Appeal form. See sample on next page. (You may get this form from KidCare or from your Department of Human Services (DHS) Local Office.) Mail or fax your written request or appeal form to -KIDCARE UNIT P.O. BOX Springfield, IL (Fax number ) OR -Your DHS Local Office OR -Mail it to the address below: KidCare Appeals 401 South Clinton, 6 th Floor Chicago, Illinois You can also appeal by calling toll-free (TTY: ) What will happen after you appeal? Someone from the central KidCare Unit in Springfield or your DHS Local Office will Review the reasons that caused you to appeal and see if they can be quickly fixed Call and ask you to attend an informal meeting to talk about your appeal. At the meeting The staff will explain why your benefits changed The staff will answer questions KidCare or your DHS Local Office may make a change in your case that you agree with or you may decide that the action appealed was right. If so, you may withdraw your appeal. Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ) 63

66 NOTICE OF APPEAL I am of Print your name Print your street address. City State Zip County Telephone Number I am asking for a fair hearing because: (Write down what the KidCare Unit did or did not do that you think is wrong. Also write why you think it was wrong.) Check one of the boxes below: I want to keep getting the medical benefits I now get until a decision is made on my appeal. If I get, KidCare Premium: I understand that I will owe premiums for benefits my family gets while waiting for the decision. I want to stop getting the medical benefits I now get while a decision is made on my appeal. My KidCare # is: My lawyer or other person helping me with this appeal, if any, is: Print the name of the person Print the address of the person Sign your name Write the date you sign File this notice by sending it to the Bureau of Administrative Hearings, 401 S. Clinton, 6 th Floor, Chicago, Illinois Under the law, the state must decide what to do about your appeal within 90 days from the date the state gets your appeal. If you win, KidCare must fix the mistake within the same 90 days. The appeal can take longer if you ask to delay your hearing. FOR AGENCY OFFICE USE: TO BE COMPLETED BY THE BUREAU OF ADMINISTRATIVE HEARINGS Date this Notice of Appeal was received. Date of postmark, if mailed (Attach Envelope). Date of written request for this hearing, if preceding this form. Date of Decision being appealed. Case Name KidCare Number KC 103KC (R-08-01) IL Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: )

67 If you still do not agree with the decision and you want to continue with your appeal, you must appear for your hearing. You will get a notice in the mail stating the date and time for your hearing. You will also receive a Statement of Facts which lists the reasons why KidCare or the Department of Human Services (DHS) Local Office made its decision. Information about the hearing The hearing is usually held in the DHS Local Office where you live. Write to the Bureau of Assistance Hearings so that arrangements can be made if you have a disability and are physically unable to come to your local office. Do this right away. Bureau of Assistance Hearings 401 South Clinton Chicago, Illinois ATTN: Paul Greene Phone: Bring records, receipts, papers, such as written proof of income, to the hearing if they help prove that KidCare or the DHS Local Office is wrong. You or your representative if you have one will have the opportunity before and during the hearing to look at all records and papers that KidCare or the DHS Local Office plans to use as evidence in the hearing. A representative is someone you ask to help you. The Department of Public Aid or the Department of Human Services will send you the decision made in your appeal. For more information ask for the pamphlet Appeals and Fair Hearings from the central KidCare Unit in Springfield or your DHS Local Office. Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ) 65

68 Grievances: If you feel you have not been treated with dignity and respect by KidCare or the Department of Human Services (DHS) Local Office employees, you have a right to file a grievance (complaint). You must put your grievance in writing and you must file it within 60 days of the day you think you were treated unfairly. You can write and sign your complaint or you can use form DHS/KC See sample on next page. You can get the form from the central KidCare Unit in Springfield or your DHS Local Office. The written complaint or form may be filed in any Department of Public Aid or Department of Human Services office in Illinois. After you file the complaint, the department reviews your grievance and decides whether to take further action. You will be notified in writing within ten days whether action will be taken. If further action is taken, a special meeting will be held with you, your representative if you have one, the employee, the employee s representative and a department staff person. A representative is someone you ask to help you. After this meeting, you will be informed in writing within 15 days of what the department decides. For more information contact the DHS Local Office or the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ). 66 Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: )

69 CLIENT GRIEVANCE FORM This form should only be used when you feel you were not treated with courtesy, consideration and respect by a Department employee. It is not to be used for appeals regarding your food stamp or assistance case. NO RETALIATION WILL BE TAKEN AGAINST YOU FOR FILING THIS COMPLAINT OR PROCEEDING WITH THE GRIEVANCE PROCEDURE. Date Form Completed: Case Number: Name Address Street Address. City State Zip Telephone Number The questions below are to be answered by the person making the complaint or by a person acting with the knowledge and consent of the person making the complaint. 1. What was the date of the incident? 2. Against whom is your complaint made? Give the name and work address of the person. 3. State the incident that prompted this grievance. Signature of the client filing grievance: Signature of the person completing the form (if someone other than the one filing the grievance): KC 2622 (N-10-01) IL Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ) 67

70 Your Civil Rights: State and Federal laws prohibit discrimination on the basis of race, sex, color, age, religion, disabling conditions and ancestry or national origin. Therefore, the Department of Public Aid and the Department of Human Services may not on the basis of race, sex, color, age, religion, disabling conditions and ancestry or national origin Deny you any services or other benefits you are eligible to receive Provide other eligible people with services or other benefits that are different from yours or provide them in a different way if you are eligible to receive them Treat you differently from other eligible people in the way you get your services or other benefits Prevent you from having the same advantages or privileges as other eligible people who receive help from the central KidCare Office in Springfield or the Department of Human Services (DHS) Local Office Treat you differently from other people in the way the central KidCare Office or the DHS Local Office determines if you are eligible to receive services or other benefits If you feel that you have been discriminated against by the Department of Public Aid, the Department of Human Services or an employee of either of those Departments you may Fill out a Client/Applicant Discrimination Claim Form DHS 4026 or DPA 185 (see samples on next four pages) which will be provided to you by the central KidCare Unit or your DHS Local Office OR Send a written complaint to one of the following addresses on pages 73 and Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: )

71 Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ) 69

72 SUMMARY OF THE COMPLAINT PROCESS 1. When a telephone interview concerning discrimination is held with a client or applicant for services or benefits the client or applicant is mailed a Client/Applicant Discrimination Claim form (DPA 185) to complete and return. The client or applicant should receive the form within five workdays of the date of the telephone interview. The client or applicant is requested to return the completed form within 10 workdays. The complaint must be filed within 180 days of the alleged discriminatory act. 2. When an interview is held in person, the client or applicant is issued the Client/Applicant Discrimination Claim form and is requested to return the completed form within five workdays. 3. When a completed Client/Applicant Discrimination Claim form is received, the Chief Equal Employment Opportunity (EEO) Officer will assign the complaint for an investigation. The client or applicant and his or her representative shall have a right to submit any relevant evidence in support of their claim. The result and recommendation of findings are submitted to the Chief EEO Officer. 4. Upon receipt of the EEO Officer's complete written report, and based on the findings, one or more of the following steps may be taken by the Chief EEO Officer: a. Direct the EEO Officer to notify the client or applicant whether or not the case appears to have merit. b. Seek additional information and or counsel the concerned parties. c. Apprise the Administrator or the Director of the current status of this complaint and make recommendations as to the course of action the Illinois Department of Public Aid should take. 5. Within 180 days (unless an extension is required) from the date the Client/Applicant Discrimination Claim was filed, the client or applicant should be informed of the action that the Department intends to take. The Illinois Department of Public Aid may extend the investigation period if necessary. The client or applicant will be advised in writing of an extension. 6. In the event the client or applicant is not in agreement with the findings of the EEO Office or has additional information which may affect the outcome of the findings of the EEO Office, the client or applicant must file an appeal in writing directly to the Chief EEO Officer within 10 days of notification of the findings. The Chief EEO Officer will submit the appeal to an Illinois Department of Public Aid Appeals Officer who will review the original findings and the appeal and make a determination based upon the available information. The client or applicant will be notified of the results of the appeal. The decision of the Illinois Department of Public Aid Appeals Officer is final. NOTE: A client or applicant who files an internal client discrimination claim through the EEO Office may also file discrimination charges with governmental regulatory agencies. These agencies include but are not limited to: the Equal Employment Opportunity Commission, 500 W. Madison, Suite 2800, Chicago, IL (312) ; the Illinois Department of Human Rights, 100 W. Randolph, Suite , Chicago, IL (312) , or 222 S. College, Springfield, IL 62704, (217) ; the United States Department of Health and Human Services / Office for Civil Rights, 105 W. Adams, 16th Floor, Chicago, IL (312) Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: )

73 Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ) 71

74 72 Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: )

75 Illinois Department of Public Aid Equal Employment Opportunity/Affirmative Action Office 401 S. Clinton, 7th Floor Chicago, Illinois (TTY) (Fax) or Illinois Department of Public Aid Equal Employment Opportunity/Affirmative Action Office Penta Building, 3 rd Floor 828 South Second Street Springfield, Illinois (TTY) (Fax) or Illinois Department of Human Services Equal Employment Opportunity/Affirmative Action Office 401 South Clinton, 3 rd Floor Chicago, Illinois (TTY) (Fax) or Illinois Department of Human Services Equal Employment Opportunity/Affirmative Action Office 425 South Fourth Street Springfield, Illinois (TTY) (Fax) or Illinois Department of Human Rights 100 West Randolph, Suite Chicago, Illinois (TTY) (Fax) Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ) 73

76 or Illinois Department of Human Rights 222 South College, Rm 101 A Springfield, Illinois (TTY) (Fax) or U.S. Equal Employment Opportunity Commission 500 West Madison Street, Suite 2800 Chicago, Illinois (TTY) (Fax) or U.S. Equal Employment Opportunity Commission 1222 Spruce Street, Rm St. Louis, Missouri (TTY) (Fax) or U.S. Department of Health and Human Services Office of Civil Rights 233 North Michigan Avenue, Suite 240 Chicago, Illinois (TTY) (Fax) or The central KidCare Unit Administrator or your Department of Human Services (DHS ) Local Office Administrator. The written complaint must be filed within 180 days of the alleged discrimination. For more information ask for the pamphlet Your Civil Rights from your DHS Local Office or the central KidCare Unit. 74 Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: )

77 Fraud & Abuse Hotline: If you know someone who is getting or using KidCare or any other benefits incorrectly or if you suspect a provider or family of fraud, you can report that to the Medical Fraud hotline toll-free number at (TTY: ). You do not have to identify yourself when calling the Medical Fraud hotline. Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ) 75

78 PART 9. SPECIAL FEATURES Your Personal KidCare Information Sheet List names and phone numbers of your doctor, dentist, eye doctor, hospital, clinic, and drugstore. Also list numbers used when your children need medical care after regular office hours and on weekends. Provider Office Phone Number After Hours Phone Number Doctor Dentist Eye Doctor Hospital Clinic Drugstore Other Write questions you want to ask your doctor. Make notes on what the doctor tells you. 76 Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: )

79 Children And Their Shots: This chart shows the shots that all children should get and the age they should get them. Use this chart to keep a record of your children s shots. AGE AND SHOTS CHILD # 1 DATE OF SHOT Birth 2 Months Hepatitis B (Hep B) 1-4 Months Hep B 2 Months Diptheria,Tetanus & Acellular Pertussis (DTaP) Polio (IPV) Haemophilus influenzae type b (Hib) Pneumococcal conjugate (PCV) 4 Months Dtap, IPV, Hib, PCV 6 Months DTaP, Hib, PVC 6 18 Months Hep B, IPV Months Hib, Measles, Mumps & Rubella (MMR), PVC Months Varicella (chicken pox) Months Dtap 4 6 Years DTaP, IPV, MMR Years Tetanus & diphtheria toxoid (Td) MMR For children who have not yet had the second dose of MMR at 4 6 years Varicella For children who have not been given a shot for chicken pox and who have not had chicken pox CHILD # 2 DATE OF SHOT See your children s doctor or clinic if you think your children may have missed any of these shots. Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ) 77

80 Healthy Children: Help your children be healthy! Healthy kids have a doctor and get regular checkups. Choose a doctor for your children and be sure to get checkups for your children at the ages shown below. To be sure your children get all of their checkups, keep track of them. Write the date of each checkup. Name of child: Age at Checkup Date of Checkup Age at Checkup Date of Checkup 2 weeks old Between age 2 and 3 1 month old Between age 3 and 4 2 months old Between age 4 and 5 4 months old Between age 5 and 6 6 months old Between age 6 and 8 9 months old Between age 10 and months old Between age 12 and 14 Be sure your child gets Between age 14 and 16 a lead screening by age 1 (12 months) Between age 16 and months old Between age 18 and months old Name of child: Age at Checkup Date of Checkup Age at Checkup Date of Checkup 2 weeks old Between age 2 and 3 1 month old Between age 3 and 4 2 months old Between age 4 and 5 4 months old Between age 5 and 6 6 months old Between age 6 and 8 9 months old Between age 10 and months old Between age 12 and 14 Be sure your child gets Between age 14 and 16 a lead screening by age 1 (12 months) Between age 16 and months old Between age 18 and months old 78 Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: )

81 Words You Need To Know Appeal: A request for a fair hearing on a decision made by KidCare or your DHS Local Office that you think is wrong. See pages If you are in a managed care plan (Americaid, Harmony Health Plan, Humana Health Plan, United Health Care of Illinois, Family Health Network), you can ask for a fair hearing for any decision made by the managed care plan that you think is wrong. See your managed care plan s member handbook or call your plan s customer service department. Central KidCare Unit: This unit in Springfield handles most KidCare mail-in applications. It also assists all families enrolled in KidCare Share, KidCare Premium and KidCare Rebate. The toll-free number is Co-payment: A small amount of money you pay each time you get medical care. DHS: Illinois Department of Human Services. Doral Dental Services of Illinois, Inc.: Doral will help you find a dentist and can provide information on dental benefits for children and pregnant women. See page 39. DPA: Illinois Department of Public Aid. DynTek: A company that okays non-emergency medical transportation in Cook County. See pages 53 and 54. Fraud: The act of providing false information to receive unfair or unlawful gains. See page 75. Grievance: A complaint. If you feel you have not been treated with dignity and respect by KidCare or DHS Local Office employees, you have a right to file a grievance. See pages 66 and 67. KidCare: The Illinois State Children s Health Insurance Program for children 18 and younger and pregnant women. There are five plans: KidCare Assist, KidCare Moms & Babies, KidCare Share, KidCare Premium and KidCare Rebate. See pages KidCare Assist: Health care coverage for children 18 or younger. Families pay no premiums or co-payments. See pages 5 and 7. Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ) 79

82 KidCare Moms & Babies: Health care coverage for pregnant women and their babies to 12 months of age. Families pay no premiums or co-payments. See pages KidCare Premium: Health care coverage for uninsured children 18 or younger. Families pay low monthly premiums and co-payments for some medical services for their children. See pages KidCare Rebate: For insured children 18 or younger who are currently covered by employer health insurance or private health insurance. Families receive money to help pay health insurance premiums for their children. See pages KidCare Share: Health care coverage for uninsured children 18 or younger. Families share in paying for their children s health care coverage and have low co-payments for some medical services. See pages Local Office: DHS office, in each county, that offers assistance like cash and medical assistance, KidCare, food stamps and other services. Medical Provider: A doctor or other person or facility that gives medical care or goods to you or your children. Obstetrician: A doctor who provides pregnant women with prenatal care. Pediatrician: A doctor who takes care of children. Personal Doctor: A doctor who provides preventive care when you are healthy and care when you are sick, and helps you get special medical care, and keeps your medical records. See page 35. Policyholder: A person to whom a health insurance policy covering a child is issued. Post-partum: The period of time after a baby is born when the mother needs special medical care. See page 48. Premium: The payment families pay for private or employer health insurance. Also, the monthly payment families pay for the KidCare Premium Plan. See pages Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: )

83 Prenatal Care: The health care a doctor or clinic gives to a pregnant woman. This is care a pregnant woman needs to improve her chance of having a healthy baby. See pages Preventive Health Care: Medical services for healthy people. These include childhood checkups or prenatal checkups. Preventive services for children include vaccinations (shots) and well-child visits. Prior Coverage: The first time children get KidCare Share or KidCare Premium, the children may be able to get payment of medical services received from two weeks before the date of application until the date KidCare coverage begins. See pages 24 and 25. Rebate: Money KidCare sends to the policyholder each month to help pay health insurance premiums for eligible children. See pages Renewal: KidCare s annual review of whether children remain eligible for one of the KidCare plans. Representative: Someone you ask to help you. See pages 65 and 66. Specialist: A doctor who can treat special medical needs if your children have them. Usually you go to a specialist if your personal doctor tells you. You go to a specialist for a specific illness or problem that cannot be treated by your personal doctor. TTY: Persons who are deaf may use these numbers and special phones to communicate. Vaccinations: Shots your children need to stay healthy. WIC: (Women, Infants and Children) WIC is a federal and state program that helps mothers, babies and children younger than age five get the healthy foods they need. See pages 56 and 57. Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ) 81

84 IMPORTANT PHONE NUMBERS AND WEBSITES KidCare Hotline: OUR-KIDS ( ), TTY: Website: Call this number to get help in finding a doctor, a dentist, other health care providers, mental health care and help for substance abuse and alcoholism. You can also call this number if you get a medical bill while your children are covered by KidCare Share or KidCare Premium or if you need information about filing a grievance. Central KidCare Unit: Call this number if you have questions about KidCare Share, KidCare Premium or KidCare Rebate, if you have changes to report and if you do not receive your I.D. Card, co-payment Tracking Form, Rebate check or a renewal form by the 11 th month of coverage. Bureau of Fiscal Operations: Call this number if you want to pay your KidCare premium by Visa or Master Card. Illinois Office of the Comptroller: Website: You may go to this website to check the mail date of your Rebate payment. Doral Dental Services: , TTY: Call this number for help in finding a dentist who takes KidCare. You may also call this number to find out if a dental service is covered. DynTek: , TTY: Call this number for approval of non-emergency medical transportation (for Cook County only). Help Me Grow Futures For Kids Help Line: (Voice and TTY) Call this number if you have questions about WIC, Family Case Management, Family Planning or special services, such as Early Intervention. Office of Rehabilitation Services: (Voice and TTY) Website: Call this number for help in finding special services. Department of Specialized Care For Children: (Voice and TTY) Website: Call this number for help in finding special services. 82 Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: )

85 Child Support Program: , TTY: Website: Call this number if you have questions about the Child Support Program and how it can help you. Appeals: (TTY: ) Call this number if you want to ask for an appeal. Appeals: Call this number so that arrangements for an appeal can be made if you have a disability and are physically unable to come to your local office. Medical Fraud Hotline: (TTY: ) Call this number if you know someone who is getting or using KidCare or any other benefits incorrectly or if you suspect a provider of fraud. Civil Rights: see pages 73 and 74 for numbers Call any of these numbers if you feel you have been discriminated against by the Department of Public Aid, the Department of Human Services or an employee of either of those Departments. DHS Local Office this number was listed on the letter telling you that your KidCare records were being sent to the Local Office serving the area where you live. If you do not know that number, the KidCare hotline can find the number for you. Call your DHS Local Office if you have questions about KidCare Assist or KidCare Moms & Babies, if you have changes to report and if you do not know how to reach your caseworker. You can also call this number for help in finding a doctor or clinic for prenatal care and for help if you get a medical bill while covered by KidCare Assist or KidCare Moms & Babies. Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ) 83

86 INFORMATION ON INTERPRETERS, KIDCARE NUMBERS AND KIDCARE WEBSITE Interpreters: The KidCare hotline workers speak English and Spanish. If you speak another language KidCare uses interpreters to talk with you. KidCare Hotline: OUR-KIDS ( ). This number is given at the bottom of each page of the handbook. The hotline representatives answer any questions about KidCare. Central KidCare Unit: Call this number when you have KidCare. You will be able to speak with a Customer Service representative about your plan. TTY Number: Call this number if you have questions about KidCare or need help in filling out forms. KidCare Website: Visit the KidCare Website at to learn more about KidCare. You may use this site to your questions and comments about KidCare. You will get a prompt reply. 84 Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: )

87 NOTES It is very important to keep track of the people you call about your health care or the health care of your children. For example, if you call a provider or caseworker, you may want to write down the following information. Name of person you spoke with Their phone number Date of phone conversation Information received: Name of person you spoke with Their phone number Date of phone conversation Information received: Name of person you spoke with Their phone number Date of phone conversation Information received: Name of person you spoke with Their phone number Date of phone conversation Information received: Name of person you spoke with Their phone number Date of phone conversation Information received: Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: ) 85

88 Name of person you spoke with Their phone number Date of phone conversation Information received: Name of person you spoke with Their phone number Date of phone conversation Information received: Name of person you spoke with Their phone number Date of phone conversation Information received: Name of person you spoke with Their phone number Date of phone conversation Information received: Name of person you spoke with Their phone number Date of phone conversation Information received: 86 Call the KidCare hotline toll-free at OUR-KIDS ( ) (TTY: )

89 KidCare Unit P.O. Box Springfield, IL PRSRT.STD U.S. POSTAGE PAID Spfld. Ill Permit No. 725